Legislature(2017 - 2018)BUTROVICH 205
03/08/2017 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Alaska Opioid Task Force | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
WEAT6HALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 8, 2017
1:36 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Cathy Giessel
Senator Peter Micciche
Senator Tom Begich
MEMBERS ABSENT
Senator Natasha von Imhof
COMMITTEE CALENDAR
PRESENTATION: Alaska Opioid Task Force
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
MICHAEL DUXBURY, Captain
Statewide Drug Enforcement Unit
Alaska State Troopers
Department of Public Safety (DPS)
Anchorage, Alaska
POSITION STATEMENT: Addressed the Alaska Opioid Policy Task
Force.
KATE BURKHART, Executive Director
Advisory Board on Alcoholism and Drug Abuse
Alaska Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Addressed the Alaska Opioid Policy Task
Force.
ANDY JONES, Chief
Section of Rural and Community Health Systems
Division of Public Health
Alaska Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Provided operational information regarding
drug-disposal bags and drug-overdose kits.
ACTION NARRATIVE
1:36:06 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:36 p.m. Present at the
call to order were Senators Giessel, Micciche, Begich, and Chair
Wilson.
^PRESENTATION: Alaska Opioid Task Force
PRESENTATION: Alaska Opioid Policy Task Force Recommendations
1:36:23 PM
CHAIR WILSON announced that the committee is hearing the Alaska
Opioid Policy Task Force's recommendations.
1:36:54 PM
MICHAEL DUXBURY, Captain, Statewide Drug Enforcement Unit,
Alaska State Troopers, Anchorage, Alaska, disclosed that he has
been employed with the troopers since 1989.
1:37:03 PM
KATE BURKHART, Executive Director, Advisory Board on Alcoholism
and Drug Abuse, Alaska Department of Health and Social Services,
Juneau, Alaska, noted that she had the pleasure of staffing the
task force.
She presented a PowerPoint presentation on the "Alaska Opioid
Policy Task Force Recommendations." She commenced with page 2,
"Alaska Opioid Policy Task Force" and referenced as follows:
· The task force is a partnership of the Alaska Division of
Public Health, Advisory Board on Alcoholism and Drug Abuse,
and Alaska Mental Health Trust Authority. It was
established to develop evidence-based policy
recommendations for preventing opioid misuse, abuse, and
overdose deaths based on information from experts from
diverse sectors, people in recovery, and community
coalitions, and the public.
· 20-volunteers served on the task force, representing people
in recovery, family members, for-profit and non-profit
treatment providers, tribal health providers, rural Alaskan
communities, Alaska Native peoples, health care providers,
law enforcement, and public safety. Ex officio
representatives from the Governor's Office, House of
Representatives, and Senate also served.
· The task force met every two weeks by video and
teleconference between May to November 2016 in open, public
meetings.
MS. BURKHART summarized that the task force came together to
help create evidence-based policy recommendations to help
communities and the state address the opioid epidemic and find
strategies that would work across different sectors in Alaska.
She referenced page 3, "Alaska Opioid Policy Task Force Members"
and noted that members hailed from all over the state and
included people from a variety of disciplines, professions, and
experiences. She said the task force members all came with an
understanding that the process would be open and participatory
that included Alaskans.
1:40:12 PM
SENATOR MICCICHE addressed the various member categories and
noted that one member was listed as "family member." He asked
Ms. Burkhart to describe what a "family member" is.
MS. BURKHART detailed that a "family member" is someone who
themselves does not experience an opioid-use disorder, but has
had a family member who has.
She referenced page 4, "Alaska Opioid Policy Task Force Process"
and detailed that the process was open, public and
participatory. She detailed as follows:
· Public comment at every meeting.
· Presenters included:
ƒLocal, state, and federal law enforcement;
ƒAddiction medicine experts;
ƒState and federal developers of prescribing
guidelines;
ƒHarm-reduction providers;
ƒFederal officials from The Substance Abuse and Mental
Health Services Administration (SAMHSA), and the
Veterans Administration;
ƒMedication-assisted-treatment providers;
ƒAlaska Department of Corrections;
ƒResidential-treatment providers;
ƒEmergency-room providers;
ƒEmergency-room physicians;
ƒEarly-childhood development and adverse-childhood-
experiences experts.
· Community and stakeholder engagement:
ƒMedical providers, recovery networks, business
community, and community coalitions.
MS. BURKHART summarized that the task force met in open meetings
with public comment at every meeting except for the last two
when recommendations were finalized.
1:42:05 PM
CAPTAIN DUXBURY set forth that one of the components of the task
force for the law enforcement professionals was the recognition
that the state cannot solely arrest, treat, educate, or prevent
its way out of the problem. He said all of the stakeholders had
to come to the table in order for the task force to approach the
problem in a different light because the problem effects a vast
swath of the state's culture
MS. BURKHART addressed the task force's presentation process
from specialists. She noted that an addiction-medicine
specialist helped start the process with an explanation of how
opioid use effects the brain and how the addiction process plays
out.
1:45:50 PM
She referenced a graphic display on page 5, "Data Snapshot,"
that addressed opioid overdoses and deaths. She specified that
the data came from the Division of Public Health. She opined
that everyone has reached consensus about the impact opioids is
having every day in Alaska.
She referenced page 6, "Public Health Framework - Public Health
Practice Paradigms" as follows:
1. Environmental controls and social determinants:
ƒReduce the need to self-medicate, control access to
addictive substances, and promote protective factors.
2. Chronic disease screening and management:
ƒDiagnose and treat addictions and substance use
disorders.
3. Acute health event control and prevention:
ƒPrevent life-threatening adverse outcomes.
MS. BURKHART noted that the task force decided early on to
approach the opioid problem from a public-health perspective, an
approach that gets to Captain Duxbury's comments that the
problem is not a one-solution problem. She disclosed that the
framework used by the task force was from the Association of
State and Territorial Health Officials (ASTHO).
CAPTAIN DUXBURY asserted that the model Ms. Burkhart explained
works well when everyone comes to the table, but said the model
does not negate the fact that law enforcement's job has to be to
interdict with people that are profiting off of other people's
misery and weakness.
SENATOR MICCICHE addressed the diagram on page 5 that says,
"Remove stigma." He remarked that when he was growing up
"stigma" was an effective deterrent. He commented as follows:
I'm just wondering how you balance that. Removal of
any stigma whatsoever with the fact that we still want
successful young people to realize that it is socially
unacceptable and extremely personally destructive to
engage in using drugs.
1:49:40 PM
MS. BURKHART answered that she agreed with Senator Micciche's
balancing-act analogy. She asserted that using evidence and data
drives policy that helps determine where the balance is. She
opined that stigma or the social consequences is actually a
barrier. She said for the larger population, programs that
provide credible information and the tools that align with
social values work better. She noted that kids start making
better choices when the alcohol messaging started to focus on
the health, social, educational, and employment consequences.
She opined that the continued "Just don't do it" messaging for
marijuana and illicit drugs does not resonate with kids.
1:52:00 PM
CAPTAIN DUXBURY admitted that his opinion is based on
experience. He opined that social media has an influence on how
people think where 600 or 1,000 friends share everything. He
asserted that the state cannot arrest its way out of the
problem. He set forth that people have to be told what the
consequences are to realize that their actions will "Erase pages
off of your resume."
SENATOR BEGICH remarked that he thought "remove stigma" was
removing the stigma of going into treatment and acknowledging
that he or she has an issue, not trying to destigmatize the use
of drugs.
MS. BURKHART concurred with Senator Begich's distinction. She
opined that there is an element that in order to seek help an
individual has to know that they are not being judged.
SENATOR BEGICH replied that he thinks being judged is okay in
opioid distinctions where a person has to go treatment.
1:55:07 PM
SENATOR MICCICHE commented as follows:
My point is I also hear a lot more these days of the
substance abuse as being a disease. Although I believe
some folks may actually have a tendency to become
addicted and abuse substances more easily, I also
think in some ways it's a little bit of a release from
personal responsibility and that's where I talk about
the relationship with stigma. Ultimately there's still
a personal responsibility.
CAPTAIN DUXBURY addressed page 7, "Reducing & Controlling
Access" on take-back prescription-drug programs and noted that
law enforcement is involved. He added that law enforcement can
also create a larger footprint by keeping some prescription
medications in homes away from children.
SENATOR GIESSEL asked Andy Jones to explain how the medication-
disposal envelope works.
1:58:45 PM
ANDY JONES, Section Chief, Emergency Programs: Health Emergency
Response Operations, EMS and Trauma, Alaska Department of Health
and Social Services, Anchorage, Alaska, explained that 25,000
"MedsAway" bags from Mallinckrodt Pharmaceuticals were donated.
He detailed that each bag is capable to dispose of 45 pills, 6
ounces of liquid, or 6 patches. He specified that water mixed
with carbon in the bags deactivates the drugs. He said the goal
is to push the bags to the state's public health centers as well
as non-profits, pharmacies, and hospitals where a drug-takeback
is an everyday thing rather than an annual occurrence.
CHAIR WILSON asked that senior centers be included as well.
MR. JONES answered yes.
2:01:19 PM
CAPTAIN DUXBURY added that the Alaska State Troopers respond to
situations where people need to get rid of medication due to an
in-home expected death.
He set forth that increased screening and security prevents the
importation of opioids. He provided the committee with
historical information on the effects of methamphetamine as well
as the current problem with opioids on native populations in
Western Alaska.
He said the threats that come to Alaska are twofold: interstate
and intrastate. He noted that troopers are dealing with
interstate drugs that are gang related and cartel influenced. He
pointed out that there's a saying that says, "Bring half as much
drugs to Alaska, but make three time as much money." He said
populations are taken advantage of where a small amount of drugs
in a small area affects everybody.
He explained that drug distribution methods include commercial
airlines, common carriers, shipping parcels, commercial
carriers, and private vehicles that include airplanes, boats or
automobiles. He summarized that the Alaska State Troopers is
getting together with other agencies and through the governor's
Five Point program to address drug distribution.
2:05:15 PM
MS. BURKHART disclosed that the task force also recommended
efforts to make full and effective use of the Prescription Drug
Monitoring Program (PDMP). She said SB 74 from the previous
legislature made some enhancements to PDMP as well as bills
recently introduced by the governor that included how often
information is uploaded to the PDMP. She added that the task
force had long discussions on alternatives to pharmacological-
pain management.
CAPTAIN DUXBURY addressed the emergency regulation to schedule
drugs that come into the state that are highly addictive and
harm people. He suggested that a process be established where a
drug is emergency scheduled and then brought to the Legislature
for ratification. He said Tramadol is drug that was scheduled by
the federal government but not by the state. He detailed the
Tramadol's harmful effects on Alaska's villages.
2:08:25 PM
MS. BURKHART pointed out that the current Legislature introduced
bills that addressed "Pink" and Tramadol. She said the task
force suggested that an emergency response modeled after the
Drug Enforcement Agency (DEA) would allow for a more immediate
response to emerging drug threats, but the response would be
subject to legislative ratification.
SENATOR GIESSEL noted that Tramadol was taken off of the
referenced bill by House Finance. She said she was hopeful that
Tramadol could be placed back into the bill when the bill
returns to the Senate.
CAPTAIN DUXBURY stated that he believes the DEA's emergency
scheduling is a great process. He noted that the drug U47700 is
having an effect in Anchorage's intercity. He opined that
emergency scheduling would make it possible to get a handle on
things a little sooner.
SENATOR BEGICH asked if legislation was introduced to create the
emergency regulatory power.
MS. BURKHART replied yes.
2:11:18 PM
She referenced page 8, "Reducing Risk of Misuse, Abuse, and
Dependence" and revealed that the task force made
recommendations related to evidence and research-based policies
that promote healthy childhood development, and to help prevent
adverse childhood experiences in order to avoid a road to
addiction.
CAPTAIN DUXBURY referenced his experiences in drug education to
avoid drugs. He noted that some people have questioned the
effectiveness of the Drug Abuse Resistance Education (DARE)
program. He opined that evidence-based education about drugs for
children can be a vehicle to make better decisions. He noted
that a DARE program in the past helped develop positive
relationships with youngsters and not having a similar program
is a detriment.
2:15:27 PM
MS. BURKHART added that the task force also made recommendations
on the importance of nutrition and having health-care providers
for a better start.
She referenced page 9, "Screening and Referral" task force
recommendations as follows:
· Expanding Screening, Brief Intervention, and Referral to
Treatment (SBIRT) to identify someone that is struggling
with drugs or alcohol.
· Information, tools, and reimbursement for pain management
specialists to screen for depression, mental health
disorders contributing to pain, refer to treatment.
· Health-plan reimbursement for clinical assessment of risk
of opioid abuse, overdoes.
· Crisis Intervention Team training, Mental Health First Aid
awareness education for law enforcement/public safety
officers.
· Public safety assisted addiction and recovery models; e.g.
Gloucester Model.
· Up-to-date information about treatment providers available
from Aging & Disability resource Centers, Alaska 211, etc.
2:18:14 PM
CAPTAIN DUXBURY explained that the Alaska State Troopers is
experiencing an issue with the "Title 47" system. He provided
detailed information on the Gloucester Model (GM) where an
individual presents their drugs to the police in order to get
help. He opined that having a "large hammer" for felony drug
possession is needed to hold over someone in order to provide
the impetus for the GM program to work, something that currently
does not exist.
MS. BURKHART said the idea of public-safety assisted addiction
and recovery models relies on having access to treatment. She
noted that most of the task force's recommendations require
additional work.
2:23:42 PM
She referenced page 10, "Opioid Use Disorder Treatment" as
follows:
· Adopt a "chronic disease management" framework for
substance-use disorder treatment policy and reform.
· Review of involuntary commitment to treatment statutes
(Title 47) as they relate to opioids.
· Access to drug courts, therapeutic justice alternatives.
· Education/continuing education for health care
professionals about state-prescribing guidelines and
addiction medicine; that is part of Governor Walkers' 5-
Point plan.
CAPTAIN DUXBURY added that there needs to be a constitutional
and legal balance to accomplish the things noted on page 10.
2:27:37 PM
MS. BURKHART referenced page 11, "Opioid Use Disorder Treatment"
and revealed that the levels of care related to the treatment is
considered one of the highest levels of care with significant
practice guidelines and regulations. She continued with
recommendations as follows:
· Comprehensive withdrawal management services in a variety
of health-care settings, specifically including rural and
correctional settings.
· Reimbursement for full costs of medication assisted
treatment that included medication, medication
administration and monitoring.
· Psychosocial treatment along with medication assisted
treatment, when clinically indicated.
· Health-plan reimbursement of inpatient, residential
substance use disorder treatment.
CHAIR WILSON pointed out correctional involvement and noted
previous complications due to overdosing. He asked if the task
force addressed treatment within the Department of Corrections
(DOC).
MS. BURKHART answered yes. She noted that the task force spent
an entire session with the medical staff from DOC.
CAPTAIN DUXBURY referenced page 13, "Overdose Prevention" and
detailed the Alaska State Troopers' involvement with Andy Jones
at DHSS regarding the use of naloxone for drug overdoses.
2:34:45 PM
SENATOR GIESSEL asked that Andy Jones describe what is in the
naloxone overdose kits.
MR. JONES explained that the overdose kits have two doses of
naloxone, a set of gloves, a CPR barrier device, and
instructions that detail signs and symptoms of an overdose as
well as how to deliver the overdose drug. He noted that the cost
for the two doses is $75. He detailed the naloxone application
process to the committee.
2:39:21 PM
MS. BURKHART said another recommendation related to overdose
prevention is ensuring that health plans have processes to
identify high-risk prescriptions.
She referenced page 14, "Syringe Exchange" as follows:
· Reimbursement of syringe exchange programs that provide
disease prevention supplies, STI screening and prevention,
and safe disposal of syringes and needles.
· Access to appropriate syringe/needle disposal services.
She referenced page 15, "Recovery" as follows:
· Health plan reimbursement of peer-support services.
· Supports for second-chance employers that are willing to
hire people in recovery.
· Support services for individuals in recovery reentering the
community from residential treatment or incarceration.
· Access to recovery networks for people in recovery from
opioid addiction, including those receiving medication
assisted treatment.
· Access to 12-step and other group recovery models in
correctional institutions.
2:42:04 PM
CAPTAIN DUXBURY pointed out that Vigor Alaska in Ketchikan is a
company that provides second chances for individuals in
recovery. He noted that he had applied Vigor's techniques in
other areas as well.
SENATOR GIESSEL noted that another company, Donlin Mine in
Southwest Alaska, has a similar story to Vigor Alaska.
MS. BURKHART said the task force observed that Alaska does not
have a way to support and spread the recovery information. She
said the task force suggested that more employers be encouraged
to become involved.
2:46:31 PM
CAPTAIN DUXBURY opined that SB 91, [crime reform bill from the
29th Legislature], has impacted the Alaska State Troopers'
ability to convince folks to get treatment or a program with a
therapeutic court due to diminished consequences for some of the
crimes. He said the troopers are concentrating on the higher
scheduled drugs that create the most damage and finding those
folks that are making the most money off of other people's
misery; however, "small folks" are able to carry 2.5 grams of
heroin, enough for 25 doses. He asserted that there are not
enough troopers to address the increase in people stealing to
buy drugs. He added that helping individuals who are affected
from the "ancillary crime" in the need to pay for drugs is an
issue being addressed as well.
SENATOR MICCICHE opined that adverse childhood experiences are
tied together with suicide, domestic violence, sexual assault,
drug abuse, and alcoholism.
2:50:13 PM
MS. BURKHART agreed with Senator Micciche that it is all
intertwined. She said very few people start with heroin and the
addiction process is a progression. She said when talking about
wellness the whole person has to be addressed.
She referenced page 16, "Collaboration" between state, tribal,
federal, and community partners working together as follows:
· Address barriers to coordination of care between
prescribers and behavioral health providers.
· Strengthen evidence-based substance abuse prevention.
· Mitigate the collateral consequences of incarceration for
drug-related offenses.
She summarized that the task force anticipates that the answers
will come through collaboration. She asserted that a framework
provided by the task force will help foster collaboration.
2:53:46 PM
She referenced page 17, "Next Steps" and detailed as follows:
· The Alaska Opioid Policy Task Force (AOPTF) was formed to
develop recommendations within a discrete time period. It
is not a formal state organization. Members contributed
their time and expertise in addition to their usual
function with their respective organizations.
· Going forward, AOPTF leadership and interested members will
work with federal, state, tribal, and local partners to:
ƒSupport implementation of recommendations;
ƒShare information about the recommendations, the research
and evidence upon which they are based, and emerging
science related to opioid misuse/abuse prevention and
treatment;
ƒAssist in coordination of opioid misuse/abuse prevention
and treatment system efforts.
MS. BURKHART summarized that the task force was never meant to
be a perpetual entity because the task force's purpose is to
provide recommendations.
CHAIR WILSON thanked the task force's efforts in bringing
forward their recommendations. He addressed page 6, "Public
Health Framework" and asked Ms. Burkhart hypothetically what
percentage she would choose to put resources into environmental
controls and social determinants, chronic disease screening and
management, or acute health event control and prevention.
2:56:48 PM
MS. BURKHART replied that the task force did not prioritize
their recommendations. She opined that prioritization should be
based on a partnership with Alaskans. She remarked that the task
force's recommendations are strong and noted that many of the
recommendations have no costs.
SENATOR BEGICH addressed page 9, "Screening and Referral." He
noted that he does SBIRT training. He opined that the SBIRT
model works and is a fairly low-cost intervention. He detailed
that the Gloucester Model is a low-cost casework model out of
Massachusetts that has been replicated throughout the country
and is a good, shared responsibility model which allows people
not to be afraid of law enforcement and law enforcement not to
be afraid others. He said he wanted to reassure Captain Duxbury
that while it is true that the Office of Juvenile Justice
rejected DARE in the 1990s, DARE "retooled" and became an
evidence-based practice over time. He addressed DOC's reentry
efforts and revealed that DOC is using evidence-based approaches
as well. He commended the task force for their recommendations
and agreed that many of the evidenced-based approaches do not
cost a lot of money.
CAPTAIN DUXBURY thanked Senator Begich for his comments and
concurred that DARE is a revamped program that teaches teachers
how to teach youngsters.
3:00:54 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Committee at 3:00 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| AOPTF Presentation to Senate HSS 3-8-17.pptx |
SHSS 3/8/2017 1:30:00 PM |
Opioid Task Force Recommendations 2017 |